title: Obstructive sleep apnoea in obese adolescents and cardiometabolic risk markers.
abstract: BACKGROUND
  In paediatric patients, obstructive sleep apnoea is associated with adiposity, especially visceral adiposity. In adults, obstructive sleep apnoea is also associated with a higher prevalence of cardiovascular disease and type 2 diabetes. There are limited and conflicting paediatric studies examining the association between obstructive sleep apnoea and biomarkers of risk for cardiovascular disease and type 2 diabetes in youth.
  
  
  CONCLUSIONS
  Obstructive sleep apnoea is linked with greater cardiometabolic risk markers in obese adolescents. Fasting insulin and homeostasis model assessment-insulin resistance may be especially linked with obstructive sleep apnoea among obese male Hispanic adolescents. The relationship between obstructive sleep apnoea and cardiometabolic abnormalities in obese adolescents should be considered when evaluating patients found to have obstructive sleep apnoea.
  
  
  BACKGROUND
  Paediatric studies examining the association between obstructive sleep apnoea (OSA) and insulin sensitivity/cardiometabolic risk are limited and conflicting.
  
  
  OBJECTIVE
  This study aims to determine if cardiometabolic risk markers are increased among obese youth with obstructive sleep apnoea as compared with their equally obese peers without OSA.
  
  
  METHODS
  We performed a retrospective analysis of 96 patients (age 14.2 ± 1.4 years) who underwent polysomnography for suspected OSA. Fasting lipids, glucose, insulin and haemoglobin A1 c (HbA1 c) were performed as part of routine clinical evaluation. Patients were categorized into two groups by degree of OSA as measured by the apnoea-hypopnoea index (AHI): none or mild OSA (AHI < 5) and moderate or severe OSA (AHI ≥ 5).
  
  
  RESULTS
  Despite the similar degrees of obesity, patients with moderate or severe OSA had higher fasting insulin (P = 0.037) and homeostasis model assessment-insulin resistance (HOMA-IR [P = 0.0497]) as compared with those with mild or no OSA. After controlling for body mass index, there was a positive association between the AHI and log HOMA-IR (P = 0.005). There was a positive relationship between arousals plus awakenings during the polysomnography and fasting triglycerides.
  
  
  CONCLUSIONS
  OSA is linked with greater cardiometabolic risk markers in obese youth.
authors.affiliation: Section of Pediatric Endocrinology and Diabetology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: S E
authors.initials: SE
authors.lastname: Watson
authors.forename: Z
authors.initials: Z
authors.lastname: Li
authors.forename: W
authors.initials: W
authors.lastname: Tu
authors.forename: H
authors.initials: H
authors.lastname: Jalou
authors.forename: J L
authors.initials: JL
authors.lastname: Brubaker
authors.forename: S
authors.initials: S
authors.lastname: Gupta
authors.forename: J N
authors.initials: JN
authors.lastname: Huber
authors.forename: A
authors.initials: A
authors.lastname: Carroll
authors.forename: T S
authors.initials: TS
authors.lastname: Hannon
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000378:metabolism; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005006:Ethnicity; D005215:Fasting; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007333:Insulin Resistance; D008055:Lipids / Q000097:blood*; D008297:Male; D063766:Pediatric Obesity / Q000150:complications / Q000453:epidemiology / Q000378:metabolism*; D017286:Polysomnography; D012189:Retrospective Studies; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000453:epidemiology / Q000378:metabolism*; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D008055:Lipids; C517652:hemoglobin A1c protein, human
keywords: Apnoea; insulin sensitivity; obesity; sleep-disordered breathing